Could Vasectomy Ever Replace The Condom?

When Scott Pope was 21, he got a vasectomy -- surgery to prevent his sperm from moving out of his testes. He had one daughter already, and his wife said it would be medically unsafe for her to carry another baby. But that marriage eventually disintegrated, and Pope, now 40 and living in California, remarried.

Pope warned his new wife that he would never be able to have kids, but she was undeterred. The couple saw roughly a dozen doctors, trying to find someone who could reverse the vasectomy. One told Pope that the procedure would cost $7,000, and that there was only a 24 percent chance of success.

"There were a lot of doctors I went to who told me it's been more than 10 years, it can't be done," Pope said.

Yet a study published in the journal Andrology this month suggests that the success rate for vasectomy reversals may be higher than previously thought -- even among men who had the surgery decades before.

Looking at the outcomes for different reversal techniques among more than 1,200 of their patients, the authors reported a sperm patency rate -- or whether moving sperm returned to the ejaculate after the vasectomy was reversed -- of 84 percent. Among men who had their vasectomy at least 15 years prior to the reversal, the chance of having a live sperm count was 75 percent, compared with 93 percent in men who had vasectomies within 15 years of the reversal. The average patient age was just over 41 years old, although patients ranged from 22 to 72.

"This is a brute force paper that says, 'This stuff works,'" argued study author Dr. Paul Turek, president of the Society for Male Reproduction and Urology, who has a private practice in California. Turek said the findings have implications for men who have changed their mind about wanting to father another child, and who have been told their best option is in vitro fertilization.

Sperm can be removed from the testicles of a man who has had a vasectomy, then combined with a woman's egg in a lab dish, but it is expensive. The American Society for Reproductive Medicine estimates that the average cost of one cycle of in vitro fertilization is $12,400 in the U.S., though there is wide variation. Turek told The Huffington Post that vasectomy reversals typically cost $8,000 to $10,000.

Notably, the study found that sperm motility, or its ability to move toward an egg, was lower after reversals in men with older vasectomies. And while it found high patency rates, experts tend to define patency as having at least one motile sperm in the ejaculate, explained Dr. Puneet Masson, director of the Male Fertility Program for Penn Fertility Care at the University of Pennsylvania. "No one," said Masson, who was not involved in the study, "is going to get pregnant on that. More compelling data would be to look at the baby take-home rates."

Masson said he finds the results of the study interesting. But he emphasized that he tells each of his patients that vasectomy is "a permanent and irreversible process." Indeed, the American Urological Association guidelines state that vasectomy should be considered a permanent form of contraception.

But Turek has a more provocative argument, saying it's unfair to compare vasectomies to condoms in considering contraceptive options.

"In some ways, vasectomy is better," Turek said. The failure rate with a condom is much higher than with a vasectomy. (Planned Parenthood estimates that there are 15 to 24 pregnancies per 100 women each year with the male condom, whereas there are less than 1 per 100 with a vasectomy -- though the cost difference is significant).

"Maybe [a vasectomy] can be considered temporary contraceptive," Turek said. (Unlike condoms and other barrier methods of birth control, vasectomies do not protect against sexually transmitted infections.)

For his part, Pope was able to have his vasectomy reversed after finding Turek's practice. He estimated the procedure cost him $10,000, which he paid out of pocket. The recovery was relatively painless, he said, and two months after the surgery, his wife got pregnant.

Now, they have a 6-month-old baby boy. But while he is thrilled with the outcome, Pope still very much so thinks of vasectomies as permanent.

"When people ask me about vasectomies, I say, 'Don't ever do it,'" he said. "You don't know what's going to happen down the road ... But if it is something you really want to go through with, there is the option that you can get it turned around."